1689695702 NPI number — LYNNCORE MEDGROUP, INC

Table of content: (NPI 1689695702)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689695702 NPI number — LYNNCORE MEDGROUP, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LYNNCORE MEDGROUP, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689695702
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/24/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5464 TEXOMA PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHERMAN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75090-2142
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
877-892-6226
Provider Business Mailing Address Fax Number:
888-625-9899

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5464 TEXOMA PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHERMAN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75090-2142
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
877-892-6226
Provider Business Practice Location Address Fax Number:
888-625-9899
Provider Enumeration Date:
07/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CATES
Authorized Official First Name:
SANDRA
Authorized Official Middle Name:
LYNN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
877-892-6226

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  0043228 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 03571381 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 885618 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 874649657 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003124518 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100251315000 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 146253716 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 688029645A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 166335301 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200059620A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100371860A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1467758 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200422920A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 625233903 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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